Clinical Surgery R Thirunavukarasu, A Abhinay
INDEX
×
Chapter Notes

Save Clear

Points in TAOchapter 1

 
TAO (THROMBO ANGITIS OBLITERANS)
  1. Affects
    1. Young male
    2. Smoker
  2. Involves
    1. Medium
    2. Small sized vessels
  3. Pathology
    1. Thrombosis—progressive obliteration of vessels
    2. Panarteritis
      Periarterial fibrosis may involve vein + nerve + lymphatics
  4. Clinical Features
    1. Claudication → rest pain
    2. Gangrene of extremities
  5. History of
    1. Thrombophlebitis of superficial and deep veins
    2. Raynaud'S phenomenon
  6. Other Examinations
    1. CVS for embolic manifestations
    2. Diabetic status
  7. Description of
    1. The gangrenous area
    2. Peripheral pulse chart
      2
zoom view
Figure 1.1: TAO—dry gangrene toe
  1. Diagnosed by
    1. Blood lipid profile + sugar
    2. Doppler ultrasonography
    3. Duplex scanning
    4. Arteriography
  2. Management
    1. Cessation of smoking
    2. Conservative:
      Vasodilators - doubtful value care of the gangrenous area
    3. Palliative:
      Amputate the gangrenous area; lumbar sympathectomy for ulcer
    4. Curative:
      Thromboendarterectomy
      Bye-pass surgery
      Omental graft
• Finding remedy is better than finding fault3
  1. Gangrene
    i. Dry
    Slow progressive arterial (putrefactive necrosis) occlusion with normal venous flow.
    ii. Wet
    Simultaneous occlusion of artery + vein sudden arterial occlusion
  2. Raynaud's Phenomenon
    W White color of affected area with blanching
    B Blue color due to stagnation of deoxygenated blood.
    C Red color due to oxygentated blood.
 
PULSE CHART
1. Dorsalis Pedis
Lateral to extensor hallucis longus tendon at the proximal end of first web space against medial cuneiform bone.
2. Posterior Tibial
Midway between medial malleolus and tendoachilles, against calcaneum.
3. Popliteal
Supine position-Knee flexed; felt against tibial condyle Prone position - Knee flexed; felt against femoral condyle.
4. Femoral Artery
Below mid inguinal point against head of femur with hip joint flexed, abducted and externally rotated.
5. Radial Pulse
Proximal to the wrist against lower end of radius.
4
6. Brachial Pulse
Medial to the biceps tendon against medial humeral condyle.
7. Axillary
Against humerus head in the axilla.
8. Subclavian
Supraclavicular fossa in the midclavicular line against first rib.
9. Common Carotid
At the level of upper border of thyroid cartilage agai nst transvese process of C6 vertebra.
10. Superficial Temporal
Anterior to the tragus against temporal bone.
Rest Pain: Severe continuous pain in the limb at rest due to severe ischemia (cry of dying nerve).
Claudication Distance: The patient often complains of pain after walking a distance.
Claudication Grades (Boyd):
G1
Pain on walking—pain relieved by continued walking.
G2
Pain on walking—pain worsened, the patient continues to walk.
G3
The pain mostly compels the patient to take rest.
Buerger's Test: Elevation of the ischemic limb causes marked pallor of limb.
(normal limb—no change even on elevation to 90°)
Buerger's Angle: The angle at which sudden pallor develops.
• Abilities not used are abilities wasted
• Many look but only few see